Healthcare Provider Details

I. General information

NPI: 1710801428
Provider Name (Legal Business Name): LOURDES MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 10TH AVE N
GREENACRES FL
33463-2208
US

IV. Provider business mailing address

4824 10TH AVE N
GREENACRES FL
33463-2208
US

V. Phone/Fax

Practice location:
  • Phone: 561-891-6844
  • Fax:
Mailing address:
  • Phone: 561-891-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARRY AUGUSTIN
Title or Position: MANAGER
Credential:
Phone: 561-891-6844